Fu Katherine A, Nguyen Peggy L, Sanossian Nerses
Department of Neurology, University of Southern California, Los Angeles, Calif., USA ; Keck School of Medicine, University of Southern California, Los Angeles, Calif., USA.
Department of Neurology, University of Southern California, Los Angeles, Calif., USA.
Case Rep Neurol. 2015 Mar 7;7(1):51-8. doi: 10.1159/000380761. eCollection 2015 Jan-Apr.
Mucormycosis is a fungal infection with the following 5 classic forms: cutaneous, pulmonary, gastrointestinal, disseminated, and rhinocerebral. The rhinocerebral form can be rapidly progressive and invasive with a high mortality rate. We present a case of a 38-year-old man with invasive mucormycosis that led to a basilar artery territory stroke. Rhinocerebral mucormycosis is an unusual cause of stroke.
A 38-year-old man with a past medical history of diabetes mellitus presented with altered mental status. A lumbar puncture revealed eosinophilic pleocytosis with a mildly elevated total protein and borderline low glucose level. CT revealed a left medullary and cerebellar infarct confirmed by MRI. MRI also displayed a diffuse marrow signal abnormality in the clivus with contiguous sinus disease. Endoscopic sinus surgery confirmed that the fungal sinusitis was mucormycosis of the Rhizopus genus, which had affected the left sphenoid sinus, invaded through the skull base, and involved the basilar artery. He was given liposomal amphotericin (500 mg i.v.) with posaconazole (400 mg i.v. twice daily). Due to the severity of the invasion and poor prognosis, the patient was discharged with comfort care measures.
Clinicians should be aware of invasive sinusitis as a rare cause of stroke in diabetics. Once the subarachnoid space and basal arteries of the brain have been invaded, the prognosis is very poor. The key to improvement of outcomes is early recognition and treatment, and examination of the sinuses on neuroimaging in all cases of stroke is vital.
毛霉病是一种真菌感染，有以下5种典型形式：皮肤型、肺型、胃肠型、播散型和鼻脑型。鼻脑型可迅速进展并具有侵袭性，死亡率高。我们报告一例38岁男性侵袭性毛霉病导致基底动脉供血区卒中的病例。鼻脑型毛霉病是卒中的罕见病因。
一名有糖尿病病史的38岁男性出现精神状态改变。腰椎穿刺显示嗜酸性粒细胞增多，总蛋白轻度升高，葡萄糖水平临界低值。CT显示左延髓和小脑梗死，MRI证实。MRI还显示斜坡弥漫性骨髓信号异常并伴有连续性鼻窦疾病。鼻内镜鼻窦手术证实真菌性鼻窦炎为根霉属毛霉病，累及左侧蝶窦，穿过颅底并累及基底动脉。给予脂质体两性霉素（静脉注射500mg）和泊沙康唑（静脉注射400mg，每日两次）。由于侵袭严重且预后差，患者出院时采取了舒适护理措施。
临床医生应意识到侵袭性鼻窦炎是糖尿病患者卒中的罕见病因。一旦蛛网膜下腔和脑基底动脉受到侵犯，预后非常差。改善预后的关键是早期识别和治疗，对所有卒中病例进行神经影像学鼻窦检查至关重要。
